Reflecting on the US Withdrawal from the World Health Organization

Heather Stoltzfus, MPH, RN, CIC, discusses the US withdrawal from the World Health Organization

(Image credit: Author)

Between April 25 and June 26, 1945, delegates and staff numbering in the thousands from 50 separate nations met together in San Francisco for a conference to agree upon the charter of the United Nations and the Statute of the new International Court of Justice, bringing the mission and vision of the United Nations to fruition on October 24, 1945.¹

At this conference, diplomats raised concerns about how a lack of global collaboration on international health threats was impeding progress in preventing and controlling diseases internationally. In the historical moments that followed, it was decided that the world would begin working together for the betterment of global health and wellness, inciting the development of an international health organization.

Their progressive visions and subsequent plans allowed for the founding of the World Health Organization (WHO) on April 7, 1948. The organization would effectively—and successfully—unite the world in a vision to “attain the highest possible level of health for all people” and a mission “to promote health, keep the world safe and serve the vulnerable, with measurable impact for people at country level.”²

Then, with just the flick of a pen, moments after his inauguration on January 20, 2025, President Trump declared his decision to withdraw the US from the WHO with executive decision, abruptly ending 8 decades of collaboration in the advancement of global health between the US, affiliated partners, and member states of the WHO.³

An Unprecedented Collaboration of Significant Global Impact

Since its inception in 1948, the WHO has united the world in advancing the health of people around the globe. Together, nations and organizations around the world have collaborated under the WHO to eradicate disease, improve access to health care, provide lifesaving vaccines, accelerate the development of new antimicrobials, respond to global health threats, prevent and control infection, provide essential humanitarian relief, and so much more.

In a statement from Association for Professionals in Infection Control and Epidemiology (APIC) president Carol McLay, DrPH, MPH, RN, CIC FAPIC, FSHEA, “APIC is disappointed in the announcement by the Trump administration to withdraw from the WHO. The WHO has long been a champion in leading efforts to drive infection prevention and control measures globally and a lynchpin in pandemic preparedness and response. The withdrawal will impact global health security, and the lack of a coordinated effort puts all nations at risk and weakens our combined efforts to combat infections.”

A Champion of Infectious Disease Prevention and Control Efforts

It only takes a brief review of history to acknowledge the significant global impact that international collaboration under the WHO has had on the advancement of international health priorities.

It is estimated that smallpox killed approximately 500 million people over 3,000 years before the WHO announced its global eradication in May 1980. In a show of unprecedented cooperation between nations of the world, the WHO led efforts to eradicate Smallpox for over 2 decades, with scientists from the US and the Soviet Union working side by side with one another. The world worked in solidarity against a common enemy, effectively ending 3,000 years of suffering from this preventable infectious disease.⁵

Yet this wouldn’t be the last time that the nations of the world would unite against a common health threat under the leadership of the WHO. Shortly after the eradication of smallpox, the HIV/AIDS epidemic would provide another opportunity for the world to rise up and unite against a common health threat.

The WHO continues to play a pivotal role in addressing the HIV/AIDS epidemic, which today is considered one of the world’s most significant public health challenges. Collaborating with member states and partnering organizations, the WHO provides key strategical support to countries, expanded HIV testing, expert evidence-based guidance, global monitoring and surveillance programs, and more. Today, due in part to the leadership and collaboration with the WHO, an estimated 30.7 million people are receiving antiretroviral treatment around the world, including 84% of pregnant women, effectively slowing the transmission of HIV and globally improving the lives of those living with the infection.⁵

The WHO has successfully led numerous efforts in identifying, preventing, and containing infectious disease threats since its founding in 1948. From Zika to Ebola, to COVID-19, to Marburg Virus, and more, the WHO continues to play an integral role in the prevention and response to global infectious disease threats, protecting and improving the health of people around the world.

The Risk of an Interconnected World

The interconnectedness of our world brings a new global health security threat never before experienced by humanity. According to data from the United Nations, an estimated 1.4 billion international tourists were recorded in 2024, an 11% increase from 2023.⁶The ease with which we can travel globally today offers numerous economic, technological, and cultural benefits while simultaneously amplifying our global health security risks. Without continued collaboration internationally to identify and respond to infectious disease threats, countries remain vulnerable to the spread of disease, and at risk for a delayed response to epidemics and pandemics.

The WHO’s international surveillance system for infectious diseases, the Global Outbreak Alert and Response Network (GOARN), allows nations, organizations, and networks to quickly identify and respond to public health emergencies. Most recently identifying and responding to outbreaks of Ebola and mpox, GOARN works to rapidly identify and contain infectious disease threats around the world. Of the 310 technical institutions providing expertise and personnel to GOARN, the US accounts for approximately 32 of them, including organizations such as the US CDC and the US Agency for International Development (USAID) Outbreak Response Team.⁷ Removing this expertise and capacity for global outbreak identification and response could have disastrous impacts on our global ability to identify and respond to infectious disease threats. It will also significantly limit the US’s access to critical global health surveillance data and public health intelligence that WHO coordinates and shares.

The Devastation of Reduced Funding to Global Health Efforts

The US is the largest financial contributor to programs and efforts led by the WHO. According to the latest data published by the organization, the US provided 1.284 billion dollars in funding during the 2022–2023 biennium, enabling the work of the WHO to advance global health priorities.⁸ The removal of this funding has far-reaching implications, both globally and nationally.

Because the WHO relies significantly on these voluntary contributions, halting funding from the US could result in significant program impact, crippling efforts to eradicate polio, respond to HIV/AIDS, strengthen health capacity in middle to low-income countries, respond to epidemics of infectious disease, or monitor for public health emergencies globally, just to name a few.This significant gap in funding could detrimentally weaken global public health security, delaying the identification and response to infectious disease threats and hampering containment efforts. The rippling effect of this decision has disastrous consequences for the world’s progress in international public health.

In an exclusive statement, Judd Walson, MD, MPH, chair of the department of international health for the Johns Hopkins Bloomberg School of Public Health, said,

“The decision announced by the Trump White House to withdraw from the WHO is deeply troubling. The work of the WHO is essential to our well-being, both as Americans and as citizens of our global community. Without a clear and effective alternative for US involvement in WHO, it is not clear how we will remain engaged in the critical role of coordinating the global response to outbreaks of public health concern, how we will support and guide the distribution of important public health goods and commodities and how we will continue to provide much needed technical assistance to support the global response to disease threats and well-being initiatives. This decision will weaken our readiness to respond to ongoing and emerging diseases of concern and will sideline the US as the rest of the world continues to work together to respond to global health challenges.”

Into Uncharted Territory

The unprecedented decision made by the Trump administration on January 20, 2025, will have far-reaching consequences for the US and the world. It is difficult to effectively summarize the success of the WHO, and what this decision does to current and future progress. It is difficult to describe the immense impact that programs under WHO have on our world.

It is devastating for those of us in public health and infection prevention to sit on the sideline and watch the devastating impact that this withdrawal will have on our global health security and the advancement of international health priorities. The collaboration and partnership between the US and the WHO is essential to international health. We are in uncharted and uncertain territory.

However, one thing is very clear: This withdrawal will not make anyone stronger. This decision puts the US and the world at risk. We were united under the WHO to improve the health of the world. It was highlighted by those delegates in 1945 that the diseases and disabilities that plague humanity are a universal experience that knows no boundaries. Collaboration against these threats is not optional. If we are to continue advancing the health of the world and protecting the health of American citizens, we can only do so together, under the leadership of an international organization that was tasked to do so.

References

1. United Nations. History of the UN: San Francisco Conference. United Nations. Accessed January 21, 2025. https://www.un.org/en/about-us/history-of-the-un/san-francisco-conference
2. World Health Organization. 75 years of improving public health: milestones. World Health Organization. Accessed January 21, 2025. https://www.who.int/campaigns/75-years-of-improving-public-health/milestones#year-1945
3. The White House. Withdrawing the United States from the World Health Organization. The White House. Published January 2025. Accessed January 21, 2025. https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization/
4. Berche P. Life and death of smallpox. Presse Med. 2022 Sep;51(3):104117. doi: 10.1016/j.lpm.2022.104117. Epub 2022 Feb 7. PMID: 35143880.
5. World Tourism Organization (UNWTO). UN Tourism: World Tourism Barometer Data. World Tourism Organization. Accessed [date]. https://www.unwto.org/un-tourism-world-tourism-barometer-data
6. World Health Organization. History of vaccination: history of smallpox vaccination. World Health Organization. Accessed January 21, 2025. https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-smallpox-vaccination
7. Global Outbreak Alert and Response Network (GOARN). About GOARN. World Health Organization. Accessed January 21, 2025. https://goarn.who.int/about
8. World Health Organization. WHO contributors: United States of America. World Health Organization. Accessed January 21, 2025. https://open.who.int/2022-23/contributors/contributor?name=United%20States%20of%20America